Provider Demographics
NPI:1992014146
Name:COMPLETE CARDIOLOGY CARE INC
Entity Type:Organization
Organization Name:COMPLETE CARDIOLOGY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LUP-SING
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-424-8440
Mailing Address - Street 1:161 N CAUSEWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5303
Mailing Address - Country:US
Mailing Address - Phone:386-424-8440
Mailing Address - Fax:386-426-8839
Practice Address - Street 1:161 N CAUSEWAY
Practice Address - Street 2:SUITE C
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5303
Practice Address - Country:US
Practice Address - Phone:386-424-8440
Practice Address - Fax:386-426-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1497782023Medicare PIN
FL1851552665Medicare PIN
FL1043488661Medicare PIN